2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC).

3D
: three-dimensional
AAA
: abdominal aortic aneurysm
AAS
: acute aortic syndrome
ACC
: American College of Cardiology
ACE
: angiotensin-converting enzyme
AD
: Aortic dissection
ADAM
: Aneurysm Detection and Management
AHA
: American Heart Association
AJAX
: Amsterdam Acute Aneurysm
AO
: aorta
AOS
: aneurysms-osteoarthritis syndrome
ARCH
: Aortic Arch Related Cerebral Hazard
ATS
: arterial tortuosity syndrome
BAV
: bicuspid aortic valve
BSA
: body surface area
CI
: confidence interval
CoA
: coarctation of the aorta
CPG
: Committee for Practice Guidelines
CSF
: cerebrospinal fluid
CT
: computed tomography
DREAM
: Dutch Randomized Aneurysm Management
DUS
: Doppler ultrasound
EBCT
: electron beam computed tomography
ECG
: electrocardiogram
EDS
: Ehlers-Danlos syndrome
EDSIV
: Ehlers-Danlos syndrome type IV
ESC
: European Society of Cardiology
ESH
: European Society of Hypertension
EVAR
: endovascular aortic repair
FDG
: 18F-fluorodeoxyglucose
FL
: false lumen
GCA
: giant cell arteritis
GERAADA
: German Registry for Acute Aortic Dissection Type A
IAD
: iatrogenic aortic dissection
IMH
: intramural haematoma
INSTEAD
: Investigation of Stent Grafts in Patients with type B Aortic Dissection
IRAD
: International Registry of Aortic Dissection
IVUS
: intravascular ultrasound
LCC
: left coronary cusp
LDS
: Loeys-Dietz syndrome
MASS
: Multicentre Aneurysm Screening Study
MESA
: Multi-Ethnic Study of Atherosclerosis
MPR
: multiplanar reconstruction
MRA
: magnetic resonance angiography
MRI
: magnetic resonance imaging
MSCT
: multislice computed tomography
NA
: not applicable
NCC
: non-coronary cusp
ns-TAAD
: non-syndromic thoracic aortic aneurysms and dissection
OR
: odds ratio
OVER
: Open Versus Endovascular Repair
OxVasc
: Oxford Vascular study
PARTNER
: Placement of AoRtic TraNscathetER Valves
PAU
: penetrating aortic ulcer
PICSS
: Patent Foramen Ovale in Cryptogenic Stroke study
PET
: positron emission tomography
RCCA
: right common carotid artery
RCC
: right coronary cusp
RCT
: randomized, clinical trial
RR
: relative risk
SIRS
: systemic inflammatory response
SMC
: smooth muscle cell
TAA
: thoracic aortic aneurysm
TAAD
: thoracic aortic aneurysms and dissection
TAI
: traumatic aortic injury
TEVAR
: thoracic endovascular aortic repair
TGF
: transforming growth factor
TI
: separate thyroid artery (A. thyroidea)
TL
: true lumen
TOE
: transoesophageal echocardiography
TS
: Turner Syndrome
TTE
: transthoracic echocardiography
UKSAT
: UK Small Aneurysm Trial
ULP
: ulcer-like projection
WARSS
: Warfarin-Aspirin Recurrent Stroke Study

Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions …

/pdf/2014-esc-guidelines-on-the-diagnosis-and-treatment-of-aortic-23h9ibdx0k.pdf

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

/pdf/2020-esc-guidelines-on-sports-cardiology-and-exercise-in-4he1udph9m.pdf

2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease.

Autores/Miembros del Grupo de Trabajo: Raimund Erbel (Coordinador) (Alemania), Victor Aboyans (Coordinador) (Francia), Catherine Boileau (Francia), Eduardo Bossone (Italia), Roberto Di Bartolomeo (Italia), Holger Eggebrecht (Alemania), Arturo Evangelista (Espana), Volkmar Falk (Suiza), Herbert Frank (Austria), Oliver Gaemperli (Suiza), Martin Grabenwoger (Austria), Axel Haverich (Alemania), Bernard Iung (Francia), Athanasios John Manolis (Grecia), Folkert Meijboom (Paises Bajos), Christoph A. Nienaber (Alemania), Marco Roffi (Suiza), Herve Rousseau (Francia), Udo Sechtem (Alemania), Per Anton Sirnes (Noruega), Regula S. von Allmen (Suiza) y Christiaan J.M. Vrints (Belgica)

2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases

BACKGROUND\nObesity in childhood is associated with increased cardiovascular risk. It is uncertain whether this risk is attenuated in persons who are overweight or obese as children but not obese as adults.\n\n\nMETHODS\nWe analyzed data from four prospective cohort studies that measured childhood and adult body-mass index (BMI, the weight in kilograms divided by the square of the height in meters). The mean length of follow-up was 23 years. To define high adiposity status, international age-specific and sex-specific BMI cutoff points for overweight and obesity were used for children, and a BMI cutoff point of 30 was used for adults.\n\n\nRESULTS\nData were available for 6328 subjects. Subjects with consistently high adiposity status from childhood to adulthood, as compared with persons who had a normal BMI as children and were nonobese as adults, had an increased risk of type 2 diabetes (relative risk, 5.4; 95% confidence interval [CI], 3.4 to 8.5), hypertension (relative risk, 2.7; 95% CI, 2.2 to 3.3), elevated low-density lipoprotein cholesterol levels (relative risk, 1.8; 95% CI, 1.4 to 2.3), reduced high-density lipoprotein cholesterol levels (relative risk, 2.1; 95% CI, 1.8 to 2.5), elevated triglyceride levels (relative risk, 3.0; 95% CI, 2.4 to 3.8), and carotid-artery atherosclerosis (increased intima-media thickness of the carotid artery) (relative risk, 1.7; 95% CI, 1.4 to 2.2) (P ≤ 0.002 for all comparisons). Persons who were overweight or obese during childhood but were nonobese as adults had risks of the outcomes that were similar to those of persons who had a normal BMI consistently from childhood to adulthood (P>0.20 for all comparisons).\n\n\nCONCLUSIONS\nOverweight or obese children who were obese as adults had increased risks of type 2 diabetes, hypertension, dyslipidemia, and carotid-artery atherosclerosis. The risks of these outcomes among overweight or obese children who became nonobese by adulthood were similar to those among persons who were never obese. (Funded by the Academy of Finland and others.).

Childhood Adiposity, Adult Adiposity, and Cardiovascular Risk Factors EDITORIAL COMMENT

Although human Cardiac Progenitor Cells (hCPCs) are not retained by host myocardium they still improve cardiac function when injected into ischemic heart. Emerging evidence supports the hypothesis that hCPC beneficial effects are induced by paracrine action on resident cells. Extracellular vesicles (EVs) are an intriguing mechanism of cell communication based on the transport and transfer of peptides, lipids, and nucleic acids that have the potential to modulate signaling pathways, cell growth, migration, and proliferation of recipient cells. We hypothesize that EVs are involved in the paracrine effects elicited by hCPCs and held accountable for the response of the infarcted myocardium to hCPC-based cell therapy. To test this theory, we collected EVs released by hCPCs isolated from healthy myocardium and evaluated the effects they elicited when administered to resident hCPC and cardiac fibroblasts (CFs) isolated from patients with post-ischemic end-stage heart failure. Evidence emerging from our study indicated that hCPC-derived EVs impacted upon proliferation and survival of hCPCs residing in the ischemic heart and regulated the synthesis and deposition of extracellular-matrix by CFs. These findings suggest that beneficial effects exerted by hCPC injection are, at least to some extent, ascribable to the delivery of signals conveyed by EVs.

Human Cardiac Progenitor Cell-Derived Extracellular Vesicles Exhibit Promising Potential for Supporting Cardiac Repair in Vitro

Induced Pluripotent Stem cells (iPSC) are adult somatic cells genetically reprogrammed to an embryonic stem cell-like state. Due to their autologous origin from adult somatic cells, iPSCs are considered a tremendously valuable tool for regenerative medicine, disease modeling, drug discovery and testing. iPSCs were first obtained by introducing specific transcription factors through retroviral transfection. However, cell reprogramming obtained by integrating methods prevent clinical application of iPSC because of potential risk for infection, teratomas and genomic instability. Therefore, several integration-free alternate methods have been developed and tested thus far to overcome safety issues. The present chapter provides an overview and a critical analysis of advantages and disadvantages of non-integrating methods used to generate iPSCs.

/pdf/non-integrating-methods-to-produce-induced-pluripotent-stem-1rqellqyyt.pdf

Non-integrating Methods to Produce Induced Pluripotent Stem Cells for Regenerative Medicine: An Overview

Following the recent advances in cardiac stem cell biology, cardiac tissue has become one of the targets of regenerative medicine. With the array of approaches that are currently being tested and the questions that they raise, it becomes increasingly clear that the regeneration of adult myocardium will require the integration of numerous factors that govern cardiac tissue biology in normal and pathological conditions. The current challenge in myocardial tissue engineering and regeneration is to establish a perfect combination of three components: cells, scaffolds, and signaling molecules [1].

Since the recognition that the mammalian heart is characterized by cardiomyocyte turnover throughout the lifespan of an individual, a number of different cardiac stem cell populations have been identified in the postnatal and adult hearts. A desirable candidate cell for cardiac tissue engineering and regeneration would be autologous, capable of differentiation into all the cardiac cell types and of functional integration, and resistant to malignant transformation. The preclinical studies and clinical trials have employed different cell types, including embryonic stem cell-derived and fetal cardiomyocytes, skeletal myoblasts, bone marrow or peripheral blood-derived endothelial progenitors, haematopoietic and mesenchymal stem cells, and recently, reprogrammed adult somatic cells (induced pluripotent stem cells). These multiple cell choices, apart from being accompanied by important ethical and safety concerns, led to a rather uniform outcome, which consisted of a low degree of improvement in cardiac contractile function. Moreover, a regenerated tissue band, which would integrate functionally with the surviving myocardium, was observed only in few cases [2].

The choice of cell population for myocardial regeneration should be based on the knowledge of stem cell biology and the mechanisms that regulate and control cardiac progenitor proliferation, apoptosis, and differentiation in the normal and pathological conditions [3]. Recently, short noncoding RNAs, named micro-RNAs (miRs), have been found to control gene expression by blocking mRNA translation and inducing its degradation. MiR-1 was among the first in this group that had been identified as regulators of muscle cell proliferation and differentiation [4]. In this special issue, F. Huang et al. demonstrated that the downstream molecular target of Notch, Hes-1, decreased, while the expression of specific cardiac genes increased, in mesenchymal stem cells infected with lentiviral vectors carrying miR-1. This miR may be useful for stimulation of cell fate decision towards cardiomyocyte lineage.

The group of M. E. Roehrich et al. identified by flow cytometry yet another stem cell population, with high expression and activity of aldehyde dehydrogenase (ALDH), in the adult heart, and the results of the characterization of these cells are published for the first time in the present special issue. This population is enriched for cells expressing Sca-1, CD34, CD90, CD44, and CD106, which indicates that it is a heterogeneous cell population, and presents mesenchymal stem cell-like differentiation potential. Interestingly, ALDH bright cells had been already sorted from human cord blood, bone marrow and peripheral blood and identified in nonhaematopoietic tissues as neural, muscle, colonic, and mammary stem cells. The activity of this enzyme allows cells to survive oxidative stress and can influence numerous functions that are crucial for stem cell survival in hypoxic environment. Indeed, cells with high activity of ALDH homed to ischemic sites (in the infarcted heart and hind limb ischemia model) and mediated local vasculogenesis [5]. Recent preliminary results indicate that treatment with ALDH bright autologous bone marrow cells is safe and may provide functional benefits in patients with chronic myocardial ischemia [6]. However, cell number and method of delivery may influence the efficacy of ALDH bright and all other cell populations used for myocardial regeneration.

Many factors determine the outcome of regenerative cardiovascular therapy and are the possible reasons behind the variable results. In fact, the methods for cell isolation and purification, the procedures for their storage or propagation, the phenotype and number of injected cells, and the methods of cell administration are hugely inconsistent between studies. The current stem cell delivery methods for myocardial repair are reviewed in the present special issue by C. C. Sheng et al. The possibilities are continuously expanding and the report of the International Society for Cardiovascular Translational Research, with the recommendations for the delivery of stem cells that would be comparable between groups [7], should be soon updated to include also bioengineered cardiac tissue transplantation.

An ideal scaffold for tissue engineering must be biocompatible, allow cell growth and differentiation, and integrate (or degrade in time-controlled manner) into the host tissue. While patch-based scaffolds for cardiac regeneration must reach the dimensions relative to infarct size in humans, comply with the tension developed in the ventricular wall during systole and diastole cycles, and still be applicable through minimally invasive procedures, injectable scaffolds must be able to pass through a small gauge catheter and reconstitute their fibrous structure through gelation. Preclinical studies indicate that the combined cell-biomaterial scaffold therapy is superior to cell therapy alone [8], but the evaluation of cellular effects in vitro would be even more reliable and easier to translate in clinical application if performed in 3D culture platforms. 3D environment and high cell density play an important role in supporting the phenotypes of cells of cardiac lineages. Many of these aspects of scaffold composition and cellular biology are discussed in this special issue.

First, the original contribution of K. Vukusic et al. describes the behaviour of cardiomyocytes, endothelial cells, fibroblasts, and c-kit-positive cardiac primitive cells in high density sphere cultures. The simple method of sphere formation and culture, starting from the pellet of cardiac cells that rounded up and formed spherical structure that floated in the culture media, adds to the previously characterized methods of cardiosphere generation (hanging drop or standard plate suspension culture). Growth of cardiac cells as cardiospheres enhanced expression of stem cell-relevant markers. Next, L. Ikonen et al. examined collagen-like synthetic self-assembling nanofiber hydrogels for their suitability for neonatal rat cardiomyocyte and human embryonic stem cell-derived cardiomyocyte culture in 2D. Although the differentiation of stem cells into cells of cardiac lineages in these hydrogels would be more indicative of their application in myocardial regeneration, it is of note that hydrogel was able to maintain the beating ability of differentiated cardiomyocytes in vitro. As such, it can represent a useful model for preclinical testing of cellular populations and stem cell-derived cardiomyocytes for tissue engineering. In addition, the research of D. Avitabile et al. offers the basis for a further optimization of stem cell and scaffold processing for myocardium repair, showing that embedding human cord blood-derived CD34+ cells into a collagen I-based hydrogel containing cytokines is a suitable strategy to promote proliferation and protect these cells from hypoxia-induced apoptosis. The properties of these injectable composites make them promising candidates for myocardial tissue regeneration and warrant further studies on their potential therapeutic application. 

With these and other scientific advances in basic science research, which provide clinicians with the tools for replacing damaged myocardium, the concept of cardiac regeneration should hopefully progress to a level that will allow the translation and application of tissue engineering triad, that is, cells, scaffolds, and signalling molecules, in the clinical setting. The success of this integrated approach will depend on the carefully designed and analyzed experiments and clinical trials.


Daria Nurzynska

Maria-Elena Padin Iruegas

Clotilde Castaldo

Patrick Muller-Best

Franca Di Meglio

/pdf/application-of-biotechnology-in-myocardial-regeneration-531jn8w05y.pdf

Application of biotechnology in myocardial regeneration-tissue engineering triad: cells, scaffolds, and signaling molecules.

Can we reduce the risk of adverse effects in selective neurolysis of the motor branches of musculocutaneous nerve? Evidence-based anatomy approach to the rescue of patients with muscle spasticity.

Cardiac regeneration is a critical endeavor in the treatment of heart diseases, aimed at repairing and enhancing the structure and function of damaged myocardium. This review offers a comprehensive overview of current advancements and strategies in cardiac regeneration, with a specific focus on regenerative medicine and tissue engineering-based approaches. Stem cell-based therapies, which involve the utilization of adult stem cells and pluripotent stem cells hold immense potential for replenishing lost cardiomyocytes and facilitating cardiac tissue repair and regeneration. Tissue engineering also plays a prominent role employing synthetic or natural biomaterials, engineering cardiac patches and grafts with suitable properties, and fabricating upscale bioreactors to create functional constructs for cardiac recovery. These constructs can be transplanted into the heart to provide mechanical support and facilitate tissue healing. Additionally, the production of organoids and chips that accurately replicate the structure and function of the whole organ is an area of extensive research. Despite significant progress, several challenges persist in the field of cardiac regeneration. These include enhancing cell survival and engraftment, achieving proper vascularization, and ensuring the long-term functionality of engineered constructs. Overcoming these obstacles and offering effective therapies to restore cardiac function could improve the quality of life for individuals with heart diseases.

The Long and Winding Road to Cardiac Regeneration

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